After Tooth Extraction

Home Instructions After the Removal of One or More Teeth

The removal of teeth is a procedure not to be taken lightly. Post-operative care is very important. Unnecessary pain and complications can be minimized if the instructions are followed carefully.

Immediately Following Surgery

  • The gauze pad placed over the surgical area should be kept in place for thirty (30) to sixty (60) minutes. After this time, the gauze pad should be removed and discarded.
  • Vigorous mouth rinsing or touching the wound area following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.
  • Take the prescribed pain medication before the numbness wears off. This will allow the medication to work more effectively.
  • Restrict your activities the day of surgery and resume normal activity when you feel comfortable.
  • Place ice packs to the side of your face where surgery was performed. Refer to the Swelling section for an explanation.
  • DO NOT SMOKE for at least three (3) days, since it is very detrimental to healing and can contribute to the development of a “dry socket”.

Bleeding

A certain amount of bleeding is to be expected for a day or two (2) following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing with cold water and wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty (30) to sixty (60) minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty (30) to sixty (60) minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited or sit upright, and avoid exercise. If bleeding does not subside, call our office for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling may not become apparent until the day following surgery and will not reach its maximum until two (2) to three (3) days after surgery. However, the swelling may be minimized by the immediate use of ice packs and keeping your head elevated above your heart.

A plastic bag filled with ice then wrapped with a towel, or an ice pack should be applied to the side(s) of the face where surgery was performed. For the first twenty-four (24) hours, ice packs should be utilized every 20 minutes (20 minutes on, 20 minutes off) while you are awake. After thirty-six (36) hours, ice has no beneficial effect. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six (36) hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling. Taking two (2) to three (3) 200mg tablets of Ibuprofen every four (4) hours may also help reduce the swelling in the first two (2) to three (3) days.

Diet

Good nutrition is extremely important for healing. Start off with clear liquids after general anesthesia or IV sedation. Do not use straws when drinking from a glass. The sucking motion can cause more bleeding by dislodging the blood clot. Once you are able, you may eat anything soft by chewing away from the surgical site(s). You may want to confine the first day’s intake to bland liquids or pureed foods (soups, puddings, yogurt, milk shakes, etc.). Avoid foods like nuts, sunflower seeds, popcorn, etc, which may become lodged in the socket(s) or surgical site(s).

Pain

Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first dose before the anesthesia has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. For more moderate discomfort, one (1) or two (2) Tylenol or one (1) Extra Strength Tylenol may be taken every four (4) hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol, unless you are on Coumadin/warfarin. Ibuprofen bought over the counter comes in 200mg tablets. Two (2) to three (3) 200 mg tablets (400 – 600mg total) of Ibuprofen may be taken every four (4) hours as needed for discomfort.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. If you do not achieve adequate relief from your prescription, you may supplement your prescription, you may supplement your prescription with two (2) to three (3) 200 mg tablets of Ibuprofen every four (4) hours, if you are NOT also on Coumadin/warfarin. Some people may even require two (2) of the prescription tablets at a time during the early stages, but that may add to the risk of upset stomach. The more severe discomfort is usually experienced within the first three (3) days after the surgery. Pain or discomfort following surgery usually subsides more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next two (2) to three (3) days. If significant pain persists for more than three days, it may require attention and you should call the office. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.

Oral Hygiene

Mouth cleanliness is essential to good healing. No vigorous rinsing should be performed the day of surgery. You may brush your teeth the night of surgery, but rinse gently. Avoid brushing the gums in the area of surgery for one (1) week. The day after surgery, you should begin gently rinsing after meals and additionally, for a total of four (4) to six (6) times a day, with an 8oz glass of warm water mixed with one-half teaspoon of salt. Continue this procedure until the gums fill in over the surgical site(s).

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur two (2) to three (3) days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

Antibiotics may be given to help prevent or treat an infection. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for one complete cycle after the course of antibiotics has been used. Call the office if you have any questions.

Nausea & Vomiting

Nausea may occur after surgery, and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each tablet with a small amount of food, then taking the tablet with a large volume of water. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for a least an hour, including the prescribed medicine. You should then sip on tea or ginger ale (after stirring out carbonation). You should sip slowly over a 15-minute period. If you are not also on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea persists for more than four (4) hours, call the office.

Sutures

Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. In most cases, sutures will dissolve unnoticed within a week. Occasionally, sutures require removal after one week. The removal of sutures is a quick procedure that requires no anesthesia or needles and is usually associated with minimal to no discomfort.

Activity

Keep physical activities to a minimum immediately following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Be aware that your normal nourishment intake may be reduced. Exercise may weaken you. If you get light-headed, stop exercising.

Other Complications

  • If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, it is important to be especially careful when eating because you could bite your lip or tongue and not feel the sensation. Call the office if you have any questions, or if the numbness persists for more than a week.
  • A slight elevation of temperature immediately following surgery is not uncommon. Tylenol may be taken to reduce the fever. If a temperature of 101°F persists for longer than a day after surgery, notify the office.
  • You should be careful going from the lying-down position to standing. Since you may not have been able to eat or drink prior to surgery, and it may be difficult to take fluids after surgery, your body may be low on fluid. Because of this, you could get light-headed if you stand up suddenly. Taking pain medications can also make you dizzy. Before standing up, you should sit for one minute and then get up slowly.
  • Occasionally, patients may feel hard projections or sharp edges in their mouth with their tongue. They are most likely the boney walls that supported the tooth, and not roots. These projections usually smooth out spontaneously in a few weeks. If not, they can be removed by Dr. Burns.
  • If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with lip balm or Vaseline.
  • A sore throat and discomfort when swallowing are not uncommon. The muscles of the throat may become swollen, so the normal act of swallowing can become painful. This should subside in three (3) to four (4) days.
  • Stiffness (trismus) of the jaw muscles may cause difficulty in opening your mouth for several days following surgery. This is a normal post-operative event that will resolve in time. Chewing solid food, gentle jaw-opening exercise or chewing gum will help relieve the stiffness.
  • A dry socket is when the blood clot gets dislodged prematurely from the tooth socket, and usually occurs between three (3) and five (5) days after tooth removal. Symptoms include a noticeable, distinct, throbbing pain in the jaw, often radiating toward the ear and forward along the jaw, causing other teeth to ache. Smoking contributes to the formation of a dry socket and can make the discomfort from a dry socket worse. Avoid smoking for at least three days after your surgery or if you develop a dry socket.

Finally

The discomfort and swelling should subside more and more after the third day following surgery. If your post-operative discomfort or swelling worsens or unusual symptoms occur, call the office for instructions.

There will be a hole or socket where the tooth was removed. The hole or socket will gradually fill in with new tissue over the next two (2) to three (3) months. In the meantime, the area should be kept clean, especially after meals, with saltwater rinses or a toothbrush.

Occasionally, small slivers of bone may work themselves to the surface of the gums during the first week or two (2) after surgery, or even up to three (3) months afterward. They are not pieces of tooth, and they usually work themselves out. Gently massaging the gums in the area can help with this process. If the pieces do not come out on their own after a week, or if you experience significant discomfort in the area, please call during office hours for assistance.

Your case is individual. No two mouths are alike. Do not accept well-intended advice from friends. Discuss your problem with the people best-able to effectively help you: Dr. Burns or your general dentist.

Brushing your teeth is okay – just be gentle near the surgical site(s).

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, call the office. Please try to call during office hours in order to obtain a quicker result. A 24-hour answering service is available if necessary. The after hours telephone numbers are 317-823-4260 or 866-823-4260.